Lilly warns on fourth-quarter revenue as Mounjaro and Zepbound sales miss forecasts

Eli Lilly said on Jan. 14 that its fourth-quarter 2024 revenue will come in about $400 million below the low end of the guidance it issued on Oct. 30, 2024, after sales of the incretin medicines Mounjaro and Zepbound grew more slowly than the company had expected ^[1]. Lilly shares fell 8% to $739.23 and were on track for their worst single-day decline in nearly four years; rival Novo Nordisk fell 3.5% ^[2].

Lilly expects fourth-quarter revenue of about $13.5 billion, up 45% from the same quarter a year earlier, and full-year 2024 revenue of about $45 billion, up 32% from 2023 ^[1]. The fourth-quarter figure includes about $3.5 billion from Mounjaro and about $1.9 billion from Zepbound ^[1]. Analysts had expected $5.35 billion from Mounjaro and $2.08 billion from Zepbound, according to LSEG data cited by Reuters ^[2]. The shortfall against Lilly's own guidance was about $400 million, or roughly 3%, below the low end of its October range ^[1].

"While the U.S. incretin market grew 45% compared to the same quarter last year, our previous guidance had anticipated even faster acceleration of growth for the quarter. That, in addition to lower-than-expected channel inventory at year-end, contributed to our Q4 results," said Lilly chair and CEO David A. Ricks ^[1]. Lilly's definition of the U.S. incretin market includes Mounjaro, Zepbound, Trulicity, semaglutide and liraglutide ^[1]. Ricks also said U.S. supply across all doses of tirzepatide was available throughout the fourth quarter ^[1].

Chief Financial Officer Lucas Montarce told Reuters that as supply normalized, wholesalers did not build up their stocks of incretins toward the end of the year the way they had in the past. "This year, given all doses are available ... that (trend) did not materialize. We finished pretty much at the same inventory level in the channel that we had in the third quarter," he said ^[2]. Channel inventory reflects what distributors order, not directly how many prescriptions were filled; fourth-quarter prescription volume for either drug has not been reported.

Lilly guided 2025 revenue to $58.0 billion to $61.0 billion ^[1]. Reuters reported the midpoint of that range was above analysts' average estimate of $58.52 billion, helped by planned Mounjaro launches in new markets ^[2]. Lilly said it expects to produce at least 60% more salable doses of incretins in the first half of 2025 than in the first half of 2024 ^[1]. Reuters reported that Mounjaro launches for obesity and type 2 diabetes in China, India, Brazil and Mexico are on Lilly's "to-do list for 2025," with no dates disclosed for individual countries ^[2].

BMO Capital Markets analyst Evan Seigerman said the forecast is "likely less a shock to investors but may still shake some confidence in incretin demand" ^[2]. Bernstein analyst Courtney Breen said the downbeat forecasts show the company needs to take steps to stimulate further demand ^[2].

Why it matters for patients

Supply availability is the practical piece here. Lilly says U.S. supply of all tirzepatide doses was available through the fourth quarter, and the company plans to produce 60% more salable incretin doses in the first half of 2025 than a year earlier ^[1]. Whether that translates into fewer refill delays or shorter waits at pharmacies has not been reported.

The revenue shortfall was tied to slower-than-expected market growth and flat wholesaler inventory, not to a safety issue; no new information about the safety of Mounjaro or Zepbound was disclosed in the announcement ^[1][2]. No changes to list prices, insurance coverage or patient assistance programs have been announced by Lilly, and none were reported by Reuters ^[2].

People taking semaglutide, sold as Ozempic, Wegovy and Rybelsus, are affected mainly through the wider market read: Lilly counts semaglutide products in the U.S. incretin market ^[1], and Novo Nordisk shares fell 3.5% the same day ^[2]. Novo Nordisk's own quarterly sales figures have not been reported.

What happens next

Ricks is scheduled to speak at the J.P. Morgan Healthcare Conference on Jan. 14 at 5:15 p.m. Eastern time, with a replay available for about 30 days ^[1]. Lilly plans to report full fourth-quarter 2024 results and 2025 financial guidance on Feb. 6, 2025 ^[1]. The figures in the Jan. 14 announcement are preliminary and unaudited and may change as financial closing procedures finish, the company said ^[1]. No timeline has been disclosed for the Mounjaro launches in China, India, Brazil and Mexico ^[2].